Assy Nimer, Pruzansky Yosef, Gaitini Diana, Shen Orr Zila, Hochberg Ze'ev, Baruch Yaacov
Liver Unit, Ziv Medical Center, Safed 13100, Israel.
J Hepatol. 2008 Jul;49(1):34-42. doi: 10.1016/j.jhep.2008.02.013. Epub 2008 Mar 27.
BACKGROUND/AIMS: Previous studies reported decreased serum IGF-1 levels in cirrhosis. We aimed to correlate GH-stimulated IGF-1 responses with both MELD and Child-Pugh scores and determine the impact of portal hypertension and nutrition on IGF-1 responses.
Fifty-three patients (56+/-2 yrs) with cirrhosis were enrolled. Serum IGF-1 levels were measured by RIA before and 24h after a single injection of GH (0.06 mg/kg).
Compared to controls, basal IGF-1 levels were significantly decreased in patients with cirrhosis (17.3+/-6.3 vs 13.6+/-5.1, P<0.001). Increments in IGF-1 levels were significantly lower in cirrhotic patients (controls: 133% vs 49% in MELD score <10, 38% in MELD score 11-18, and 13% in MELD score 19-24, p<0.001). 37% of patients had blunted IGF-1 responses. Increments in IGF-1 levels correlated with albumin (r=0.6), portal congestive index (r=0.4), and MAMC (r=0.25). By multivariate analysis, only CP (OR 5.7) and MELD scores (OR 4.5) accurately differentiated between blunted or non-blunted IGF-1 responses and not portal hypertension (OR 0.9) or malnutrition (OR 1.35).
Cirrhosis is associated with low IGF-1 levels and an attenuated response to exogenous GH. These findings correlate better with the extent of hepatic dysfunction rather than the presence of portal hypertension or malnutrition.
背景/目的：既往研究报道肝硬化患者血清胰岛素样生长因子-1（IGF-1）水平降低。我们旨在将生长激素（GH）刺激后的IGF-1反应与终末期肝病模型（MELD）评分及Child-Pugh评分相关联，并确定门静脉高压和营养状况对IGF-1反应的影响。
纳入53例（56±2岁）肝硬化患者。单次注射GH（0.06mg/kg）前及注射后24小时，采用放射免疫分析法（RIA）测定血清IGF-1水平。
与对照组相比，肝硬化患者的基础IGF-1水平显著降低（17.3±6.3 vs 13.6±5.1，P<0.001）。肝硬化患者IGF-1水平的升高显著低于对照组（MELD评分<10者：对照组升高133%，肝硬化患者升高49%；MELD评分11 - 18者，肝硬化患者升高38%；MELD评分19 - 24者，肝硬化患者升高13%，p<0.001）。37%的患者IGF-1反应迟钝。IGF-1水平的升高与白蛋白（r = 0.6）、门静脉充血指数（r = 0.4）及上臂中部肌肉周长（MAMC，r = 0.25）相关。多因素分析显示，只有Child-Pugh评分（比值比[OR] 5.7）和MELD评分（OR 4.5）能准确区分IGF-1反应迟钝或正常，而门静脉高压（OR 0.9）和营养不良（OR 1.35）不能。
肝硬化与低IGF-1水平及对外源性GH反应减弱相关。这些发现与肝功能障碍程度的相关性更好，而非与门静脉高压或营养不良的存在相关。
